COSHOCTON – County residents should choose the level of safety services they want and they will need to make that decision with their wallets, according to the commissioners.

Loss of government funding is estimated to cause a shortfall for many county agencies in the second half of 2019, including the Coshocton County Sheriff’s Office and Prosecutor’s Office. However, the financial need is more eminent for Coshocton County Emergency Medical Services. Executive Director Todd Shroyer believes he’ll have to borrow against incoming funding from a property tax levy to make one or both payrolls in March, depending on how money from insurance billing for patients is received. EMS is currently running on its 2017 carryover balance of approximately $426,000.

A 1-mill countywide property tax levy for EMS operations is expected to be on the spring primary ballot and would generate $770,175 a year. This would be in addition to a 3-mill levy first approved by voters in 2003 that generates about $1.8 million a year. The sheriff’s office and prosecutor’s office are in discussions about an operations levy for the fall ballot with millage and what it would go toward to be determined. Funding from operations levies would not be earmarked for any capital improvements, such as a new jail that has long been in talks or renovations to the former Tribune building EMS bought in 2017 for a new headquarters.

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A magnet advertising for an earlier levy for Coshocton County Emergency Medical Services displayed in their Chestnut Street office. A 1-mill countywide levy for EMS operations is expected to be on the spring primary ballot.(Photo: Sara C. Tobias/Coshocton Tribune)

Officials of all agencies said they don’t want to ask local residents for more money, but feel their hands have been tied from the state.

Local government funding taken away in the 2008 Recession, about $1 million locally, has not been replaced and Coshocton County has reached the cap on what it can collect in sales tax. Right now property tax levies are the only way commissioners said they can generate a major, consistent revenue stream. They wish Gov. John Kasich would tap into the state’s more than $2 billion rainy day fund, per the Office of Budget and Management, to help out small, struggling counties like Coshocton, but Kasich has vowed those funds won’t be touched while he’s governor.

While different factors play into the need for more funding, the growing opiate crisis is a major element. The sheriff’s office and prosecutor’s office have seen an increase in drug related cases and EMS deals with more patients having drug overdoses. Still, local officials believe they could get by fine if they just had taken away state funding.

EMS needs

Currently, EMS has four crews on all shifts and sometimes five depending on available part-time workers. They have stations in Coshocton, West Lafayette and Warsaw. Shroyer said he’s considering going down to three crews per shift and could implement that in the summer. That could create longer response times, reliability concerns and issues when multiple calls are being handled at the same time. Shroyer estimates they will receive about 5,000 calls in 2018.

So far, Shroyer has tried to save money by cutting eight positions due to attrition and buying used equipment and vehicles. No new ambulances have been purchased since 2012. He’s also exploring the option of returning billing in-house instead of contracting with a third-party. Additionally, they could go back to hard billing from soft billing, meaning private insurance patients would be billed for what their insurance doesn’t cover. While it was not part of official ballot language, Shroyer said county residents were promised with the 2003 levy that they would not be charged anything for EMS service.

Shroyer attributed loss of funding to the downturn in the local economy in the recession, low Medicaid reimbursement rates, billing issues and the de-evaluation of the American Electric Power Plant in Conesville.

EMS took a $113,730 hit to tax revenue last fall according to the Coshocton County Auditor’s Office when state appraisers lowered the value of the AEP facility from $72.7 million to $34.7 million.

Medicaid maxes out at $154 for a transport and $1.45 per mile traveled with a patient. Shroyer said this doesn’t come close to covering actual treatment costs as a standard transport can be billed at more than $1,000. As an example of costs, Shroyer said Narcan for drug overdoses is $40 a dose, a needle used for drilling when an IV can’t be established is $135 each and Glucagon to raise the blood sugar of a diabetic costs about $200 a dose. Shroyer said they spent $87,858 in medications and supplies for 2017.

Shroyer estimates Medicaid reimbursement per patient is about 10 cents on the dollar. Reimbursement for private insurance is between 60 to 70 cents on the dollar. He hopes to bring in about $960,000 in revenue from patient billing in 2018, which is down from $1.6 million in 2013. Due to loss of local jobs, patients that once had private insurance now have Medicaid and that’s caused a significant drop, Shroyer said.

“Medicaid can’t cover the costs and that’s where the tax levy comes in,” Shroyer said. “Our Medicare hasn’t changed. Our people who have no health insurance hasn’t changed. What we’ve seen is a move from patients that used to have health insurance now have Medicaid.”

About a quarter of patients have Medicaid, a quarter have private insurance and the remaining half have Medicare or a combination of Medicare and Medicaid, Shroyer said. About 80 percent of EMS runs are in Coshocton, West Lafayette or the two surrounding townships of those municipalities.

Shroyer knows that the purchase of the former Tribune building and renovations, estimated around $700,000 total, doesn’t look good in the timing. However, they’ve long outgrown their current station on Chestnut Street and the new building will save on money in the long run and allow for more training opportunities.

He compared it to a newly married couple with a baby who are working and living in a one-bedroom apartment. A two-bedroom apartment opens up in their building for just $50 more a month and they move in. Then one member of the couple loses their job.

“The reason they’re in trouble is not the $50 in rent, it’s the fact that they lost a half of their income,” Shroyer said.

Other safety service issues

Prosecutor Jason Given is expecting between 180 to 200 indictments from his office for 2018. He said with the personnel his office and Coshocton County Common Pleas Court has “the bows of the ship start to creak” at about 150 indictments. He was looking at hiring another attorney for the office, but those plans have been put on hold because of financial concerns.

For 2017, 85 drug dealers were taken into custody and abuse, dependency and neglect cases topped 100. Given said those types of cases from Coshocton County Job and Family Services used to be in the range of 15 to 25 a year and he believes that rise is tied to substance abuse as well.

“What that does is have a ripple effect. It sends all these people into our local system, but our local jail can’t handle that kind of an influx. Right now we can barely house what we have,” Given said.

Commissioner Dane Shryock said the need for a new jail is there, but personnel and operations funding for the prosecutor’s office and sheriff’s office also needs addressed. Even if a new justice center would be created, Lt. Dean Hettinger of the sheriff's office said at least five new employees would be needed to run it. The sheriff’s office is down about 10 employees total from pre-recession heights.

Shryock said the local community has lost a little more than $1 million over the past seven years from the state. He said the county overall looks good for 2018, but things get bleak in the middle of 2019 without increased state funding or some other revenue streams.

“This has all affected our ability to provide the services this community has had for the last number of years. It’s probably going to be in crisis stage in the next several months and by that I mean providing the type of services this community is used to without further reductions,” Shryock said. “We know what the future is like and what is coming. I don’t think the average person understands that or knows that yet.”

Given praises the commissioners on how they weathered the financial storm of the recession, but eventually the lack of state assistance will take its toll.

“At some point, the county has to yell uncle and go to the taxpayers and ask for help. Frankly, the state has taken away so much funding while giving us no other option,” Given said.

Shryock said this all comes back to giving the community what they want and if they want safety services at the level they are now at least, they have to pay for it.

“The issue we’ve faced here is does three people make those decisions or do we say 'no, we don’t make those decisions, public what do you want,’” Shryock said of the three commissioner panel. “We can’t write these dollars in there and put this burden on them. They have to say they want it.”